Uterine Torsion Due to Migration of a Nontwisted Ovarian Teratoma in a 1-Year-Old Girl: A Case Report

Abstract

We present the case of a 1-year-old girl who presented to a local hospital with abdominal pain. A 10-cm calcified tumor was found in her right abdomen. She was suspected of having ovarian tumor torsion and was transferred to our hospital. We decided not to perform emergency surgery on the day of her admission, as blood flow could still be detected in the ovarian tumor. However, the next day, emergency surgery was performed owing to the exacerbation of her anemia and inflammatory reaction and the whorled appearance of her uterus on magnetic resonance imaging. Intraoperative examination revealed a congested uterus that was rotated 180 degrees in the clockwise direction. However, the left ovarian tumor was not twisted. We considered that the uterine torsion occurred because the left ovarian tumor pulled on it as it migrated to the right flank. The left ovarian tumor was enucleated, and the uterus was preserved, as evidenced by the restoration of its normal color after the release of the twist. The ovarian tumor was diagnosed on the basis of histopathological findings as a teratoma. Uterine torsion is a very rare condition, defined as uterine rotation of more than 45 degrees around the longitudinal axis. Most cases are seen in pregnant women or in elderly women with myoma of the uterus. This was the second pediatric case reported in Japan and, to the best of our knowledge, the youngest case reported worldwide.